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Study: Sleeping position may worsen glaucoma
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Sleeping positions and asymmetric visual field loss in open-angle glaucoma patients may be related, according to a new study in the American Journal of Ophthalmology.
"People generally spend between one-quarter and one-third of their lives sleeping," Kim and colleagues wrote. "During sleep, body position varies between the supine position and the lateral decubitus position, often more on one side than the other. Thus, IOP elevation related to the lateral decubitus position might play a role in glaucoma progression."
The authors studied 692 patients with bilateral normal-tension glaucoma or high-tension glaucoma. Participants took a questionnaire to determine their preferred sleeping positions and were labeled with a better eye and worse eye.
The researchers found that of the enrolled participants, 62.1% had asymmetric visual field loss between their eyes. Among the 309 bilateral normal-tension glaucoma patients, 100 preferred to sleep on their side, and 66 of those patients chose to sleep with their worse eye downward. Among the 121 high-tension glaucoma patients, 32 preferred to sleep on their side, and 23 of those patients chose to sleep with their worse eye downward.
"Our results suggest that the sleep position habitually preferred by glaucoma patients may be associated with greater visual field loss," the authors concluded.
They also recommended additional studies, including using video recording during sleep instead of a questionnaire to collect more exact data.
Perspective
Back to TopLee Peplinski, OD, FAAO
It is well accepted that supine IOP levels are higher than those measured when seated. Further studies have confirmed that the extent of this difference is greater in glaucoma patients than in normal subjects. Additionally, preferred sleeping position may contribute some asymmetry to this equation.
The exact mechanism for this difference is not yet determined, but likely relates to blood flow changes within the episcleral venous system and the choroid. The authors suggest these dynamics may be significantly related to sleeping position and may remain independent of optic nerve perfusion.
One limitation of this study is the retrospective cross-sectional nature of the analysis. It has been acknowledged that further study with a prospective design and more exact data collection is in order.
We have all had glaucoma patients that we thought were well controlled with stable IOP measurements in the office, yet they seemed to be losing additional visual field, perhaps more in one eye than the other. It is worth considering that the patient’s preferred lying position during sleep may be a contributing factor. Remember to include this questioning when appropriate, educate patients when necessary and always remain vigilant to the small details.
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